Unnecessary tests, prolonged ICU stays, compromised patient safety: AIIMS doctors warn against VIP culture in hospitals
New Delhi: The practice of providing preferential treatment to influential individuals can result in compromised patient safety and access to equitable patient care, AIIMS doctors have warned.
In an article published in Oncology Reviews, Dr. M D Ray, Professor of Surgical Oncology at AIIMS, Delhi and his MCh student Dr. Hema Siri Kottu examined the ethical and clinical challenges that the doctors face while dealing with "VIP syndrome", where high-profile patients receive preferential treatment that deviates from standard medical protocols.
The authors have explained in the article the challenges that arise in practice, particularly with patients seeking VIP treatment. According to them, these challenges often stem from interference from management or external pressures and it is not limited to patients of high socioeconomic or professional status only, as it extends to relatives of healthcare providers as well.
The article mentions how such interferences "influence patient care" and pose challenges for the doctors. "Even within the medical community, when treating fellow doctors, there can be a tendency towards overcaution, leading to undue anxiety over minor conditions. Addressing these challenges requires maintaining the principles of the Hippocratic oath while navigating pressures that may compromise equitable patient care," it said.
"While special accommodations for high-profile individuals may be acceptable if they do not compromise access or the quality of care for others, healthcare providers must be vigilant," the authors have concluded.
In the article, the authors have discussed the challenges faced by oncosurgeons with VIP patients, the patients, and hospital staff. It also lays down the do's and don'ts for doctors while caring for VIP patients.
Referring to their clinical experiences in surgical oncology, the authors described how pressure from patients, their relatives or hospital administrators results in unnecessary investigations, surgery without adequate preoperative preparation, and prolonged intensive care unit (ICU) stays. This ultimately can expose patients to unnecessary delays in treatment, confusion, and avoidable complications.
"The resources and attention devoted to VIP patients can indirectly affect non-VIP patients. When physicians and staff are preoccupied with high-profile cases, the care and attention given to regular patients may diminish, leading to delays or substandard treatment," explained the authors.
In the article, the authors recount the case of a 58-year-old woman with advanced ovarian cancer. Following pressure from hospital management, the patient underwent surgery without adequate preoperative preparation.
These pressures extended beyond admission, influencing decisions such as prolonged ICU stays postoperatively, which were not necessary. Consequently, her recovery was complicated by delayed ambulation, leading to postoperative basal atelectasis and subsequent pulmonary complications. Her hospital stay extended to 12 days, whereas patients typically undergoing similar surgeries are discharged within 5 days, the authors said.
They also referred to the case of a 60-year-old woman with early breast cancer. In this case, the relatives insisted on a PET-CT scan despite there being concerns regarding its necessity. The results showed increased uptake in mediastinal lymph nodes, leading to further investigation, which ultimately found the changes to be reactive. Referring to this, the authors explained that delays caused by such demands can lead to disease progression and worsened outcomes.
The authors also pointed out that VIP patients often request special considerations such as early surgeries or preferential treatment in outpatient departments (OPDs) and wards.
"However, rushing surgeries without proper pre-operative optimization, such as managing recent smoking history or uncontrolled diabetes, can increase perioperative complications significantly," they explained.
They also addressed situations where patients demand prolonged stay in the ICU as a caution. However, the authors pointed out how this can lead to additional complications for the patient.
"The desire for prolonged intensive care unit (ICU) stay for “extra attention” can reflect a combination of anxiety, fear of complications, or perhaps a perception that her needs are not being met adequately in a standard ward setting. This situation can lead to conflicts in care priorities; while the staff aims for efficient use of resources and optimal discharge protocols, the patient’s request for longer stay can create complications," they said.
Further, they highlighted how demands for frequent visits by senior doctors, unnecessary antibiotics, extended stays in hospital and interference in postoperative care can also put pressure on healthcare professionals and disrupt hospital workflows.
In the article, the authors have also discussed how patients may complicate their own treatment when they seek multiple opinions and unnecessary investigations, or rely on unverified online information or withhold important medical histories. "With access to abundant medical information online, some patients arrive with preconceived diagnoses and treatment plans, often from unreliable sources. This can lead to distrust in medical professionals and challenges in establishing effective doctor-patient communication," said the authors.
They have laid down five principles while caring for VIP patients. These include establishing stringent admission criteria, enhancing communication, ensuring equitable distribution of care, providing support for security staff, and enforcing strict discharge criteria.
"Ensuring that time and care are allocated based on patient needs rather than their status or demands promotes fairness and efficiency in healthcare delivery," the article mentioned.
The authors said documenting and sharing real-world clinical experiences can help sensitise healthcare professionals to the problem, encourage institutional discussions and promote uniform policies to safeguard equity in patient care.
“By openly acknowledging these situations, we not only validate the experiences of clinicians but also promote preventive strategies that can mitigate the negative consequences of preferential treatment,” they said.
According to a PTI report, Dr Ray said every patient deserved dignity, compassion and appropriate treatment, and hospitals must protect clinicians’ ability to make decisions based on medical need.
“Asking questions and seeking a second opinion are legitimate patient rights; pressure to bypass essential safeguards is the concern,” he said.
The authors noted that their article presents clinical experiences and ethical concerns rather than findings from a controlled comparative study.
They argue that raising awareness of VIP syndrome and establishing consistent institutional protocols are important to protecting patient safety, fairness in access to care, and public trust.
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